Imaging appearances of metastases from neuroendocrine tumours of the pancreas

Imaging appearances of metastases from neuroendocrine tumours of the pancreas

M P Debray, MD ¹ O Geoffroy, MD ¹ J P Laissy, MD, PhD ¹ R Lebtahi, MD ² O Silbermann-Hoffman ¹ M C Henry-Feugeas, MD, PhD ¹ G Cadiot, MD, PhD ⁴ M Mignon, MD, PhD, FRCP(London) ³ and E Schouman-Claeys, MD ¹

Departments of ¹Radiology, ²Nuclear Medicine and ³Gastroenterology, Bichat-Claude-Bernard Hospital, 46 rue Henri Huchard, 75877 Paris Cedex 18 and ⁴Department of Gastroenterology, CHU de Reims, 51092 Reims Cedex, France

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Figure 1. Because they frequently grow slowly, metastases from endocrine tumour of the pancreas (ETP) may attain a large volume without rapidly compromising life expectancy. On this contrast enhanced CT, the entire right lobe of liver and the fourth segment contain confluent metastases from a non-functional ETP. Coeliac lymphadenopathy is present.

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Figure 2. Multiple liver metastases of a non-functional endocrine tumour of the pancreas showing (a) moderate to high hyperintensity on T₂ weighted MR images, (b) hypointensity on T₁ weighted images and (c) enhancement that is either homogeneous or peripheral after iv gadolinium chelate. (d) Octreoscan, which detected not only this diffuse liver involvement but also multiple metastases in the skull, thoracic spine, ribs, pelvis, shoulders and femurs, provides whole-body metastatic screening.

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Figure 3. MRI showing pseudoangiomatous liver metastasis from a non-functional endocrine tumour of the pancreas. T₂ weighted spin echo image shows a homogeneous, hyperintense, sharply limited nodule in the posterior sector of the liver, mimicking haemangioma (left). Gradient recalled echo image obtained 40 s after injection of gadolinium chelate shows peripheral non-globular enhancement of the lesion (right), which was no longer visible on delayed images (not shown).

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Figure 4. (a) Gastrinoma liver metastases on CT following iv iodinated contrast medium are markedly enhanced during the arterial phase. (b) Some of the metastases are difficult to detect during the portal venous phase. Low attenuation and calcified lesions are the result of prior chemoembolisation.

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Figure 5. Vipoma liver metastasis is hyperechoic, with irregular and ill defined margins.

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Figure 6. Lateral radiograph of the lumbar spine shows heterogeneous sclerosis of the body and anterior part of the pedicles of the second lumbar vertebra, indicative of mixed osteolytic and osteosclerotic spinal metastases of a non-functional endocrine tumour of the pancreas.

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Figure 7. Numerous gastrinoma metastases in L1–L4 vertebrae are (a) hypointense on T₁ weighted MR images and (b) hyperintense on T₂ weighted MR images. (c) They are partly enhanced after iv gadolinium chelate.

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Figure 8. The multiple lung nodules on this chest radiograph are metastases from a gastrinoma.

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Figure 9. (a) Lung nodule on CT. Although Octreoscan was more sensitive, detecting a hot spot before the nodule became visible on CT, thoracic CT performed several months later precisely located the nodule in the right superior lobe close to the ventral bronchus (arrow). (b) In another patient with insulinoma and gastrinoma related to multiple endocrine neoplasia type-1 (MEN 1), an enhanced mass in the anterior mediastinum on CT proved, after histological examination of the resected tumour, to be a thymic carcinoid. In both cases, neither radiological imaging nor somatostatin receptor scintigraphy was able to distinguish a solitary lung or mediastinal node metastasis from a primary bronchial or thymic carcinoid related to MEN 1.

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Figure 10. Peritoneal carcinomatosis in a patient with a non-functional endocrine tumour of the pancreas. CT shows multiple enhanced nodules (arrows) involving the peritoneum adjacent to the rectum, associated with ascites (arrowheads).